A systematic review and meta-analysis of outpatient treatment for acute diverticulitis
| Autor: | Johannes A. Otte, A. A. W. van Geloven, Bastiaan R. Klarenbeek, W. A. van Enst, R. J. F. Felt, J. B. C. M. Puylaert, Kelly Bos, S. T. van Dijk, Werner A. Draaisma, M.G.J. de Boer, Marja A. Boermeester |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Percutaneous medicine.medical_treatment Review 030230 surgery Patient Readmission 03 medical and health sciences 0302 clinical medicine Internal medicine Outpatients medicine Humans Acute diverticulitis Abscess Digestive System Surgical Procedures Diverticulitis Inpatients business.industry Gastroenterology Home treatment Immunosuppression Hepatology medicine.disease Comorbidity 3. Good health Uncomplicated diverticulitis Costs Meta-analysis Emergency medicine Acute Disease Outpatient treatment Drainage 030211 gastroenterology & hepatology Emergencies business |
| Zdroj: | International Journal of Colorectal Disease International Journal of Colorectal Disease, 33(5), 505-512 van Dijk, S T, Bos, K, de Boer, M G J, Draaisma, W A, van Enst, W A, Felt, R J F, Klarenbeek, B R, Otte, J A, Puylaert, J B C M, van Geloven, A A W & Boermeester, M A 2018, ' A systematic review and meta-analysis of outpatient treatment for acute diverticulitis ', International Journal of Colorectal Disease, vol. 33, no. 5, pp. 505-512 . https://doi.org/10.1007/s00384-018-3015-9 |
| Popis: | Background The shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient treatment, potentially reducing the burden of one of the most common gastrointestinal diseases in the Western world. Purpose Assessing the safety and cost savings of outpatient treatment in acute colonic diverticulitis. Methods PubMed and EMBASE were searched for studies on outpatient treatment of colonic diverticulitis, confirmed with computed tomography or ultrasound. Outcomes were readmission rate, need for emergency surgery or percutaneous abscess drainage, and healthcare costs. Results A total of 19 studies with 2303 outpatient treated patients were included. These studies predominantly excluded patients with comorbidity or immunosuppression, inability to tolerate oral intake, or lack of an adequate social network. The pooled incidence rate of readmission for outpatient treatment was 7% (95%CI 6–9%, I2 48%). Only 0.2% (2/1288) of patients underwent emergency surgery, and 0.2% (2/1082) of patients underwent percutaneous abscess drainage. Only two studies compared readmission rates outpatients that had similar characteristics as a control group of inpatients; 4.5% (3/66) and 6.3% (2/32) readmissions in outpatient groups versus 6.1% (4/66) and 0.0% (0/44) readmissions in inpatient groups (p = 0.619 and p = 0.174, respectively). Average healthcare cost savings for outpatient compared with inpatient treatment ranged between 42 and 82%. Conclusion Outpatient treatment of uncomplicated diverticulitis resulted in low readmission rates and very low rates of complications. Furthermore, healthcare cost savings were substantial. Therefore, outpatient treatment of uncomplicated diverticulitis seems to be a safe option for most patients. Electronic supplementary material The online version of this article (10.1007/s00384-018-3015-9) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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